The Effect of Charcot Neuroarthropathy on Limb Preservation in Diabetic Patients with Foot Wound and Critical Limb Ischemia after Balloon Angioplasty

Prevalence, Characteristics, and Prognosis of Peripheral Arterial Disease in Patients With Diabetic Charcot Foot

Charcot foot (CF) is a rare complication of diabetes associated with foot deformities and foot ulcers. Peripheral arterial disease (PAD) is a factor of poor prognosis in patients with diabetic foot ulcers (DFUs). However, PAD has infrequently been studied in CF. We aimed to determine the prevalence, the characteristics and the prognosis of PAD in a large group of patients with diabetic CF. We retrospectively compared 56 patients with diabetic CF to 116 patients with diabetic foot without CF. The prevalence of PAD in patients with CF was 66.1%. Compared to patients without CF, patients with CF had similar risks to have PAD (OR 0.98, 95%CI 0.50-1.94, p= .97) and neuro-ischemic DFUs (OR 1.19, 95%CI 0.57-2.49, p= .65), more risk to have lesions of distal arteries (OR 4.17, 95%CI 1.76-9.94, p= .001) and less risk to need revascularization (OR 0.14, 95%CI 0.06-0.36, p< .001). In patients with CF, PAD was strongly predicted by DFUs (OR 24.55, 95%CI 1.80-334.43, p= .016) and coronary artery disease (OR 17.11, 95%CI 1.75-167.43, p =.015). Survival rate and limb salvage rate in patients with CF were not worsened by PAD and by neuro-ischemic DFUs, respectively. In conclusion, we show that PAD should not be overlooked in patients with diabetic CF, especially in those having DFUs or coronary artery disease. PAD in patients with CF differed from that of patients without CF since it predominated in distal arteries and required less often revascularization.

Successful application of extracorporeal circulation compression perfusion in the treatment of diabetic foot: a retrospective cross-sectional study

OBJECTIVE

To investigate the clinical effect of extracorporeal circulation compression perfusion (ECCP) in the treatment of diabetic foot.

METHODS

We retrospectively evaluated 89 patients with diabetic foot admitted from January 2017 to April 2019. The patients were grouped according to whether they received ECCP treatment; experimental group: 27 patients, controls: 62 patients. After applying the inclusion criteria and exclusion criteria, there were 21 patients in the experimental group and 21 patients in the control group. Foot microcirculation was evaluated by measuring the percutaneous oxygen partial pressure (TcPO₂) and infrared thermography (IRT). Wound healing time and ulcer recurrence rate 1 year after discharge were compared between the groups.

RESULTS

TcPO₂ and IRT values in the experimental group differed significantly compared with the control group. Foot ulcer healing time in the experimental group was shorter than that in the control group (17.10 ± 3.08 days vs 25.38 ± 4.40 days, respectively), and the recurrence rate after 1 year in the experimental group was lower than that in the control group (2/21, 9.5% vs 9/21, 42.8%, respectively).

CONCLUSION

ECCP improved foot microcirculatory perfusion in diabetic foot treatment. ECCP has clinical practicality and may accelerate wound healing speed and reduce ulcer recurrence.

The Charcot Neuroarthropathy as Onset of Type 2 Diabetes - a Diagnostic Challenge

Introduction: The Charcot neuro-osteoarthropathy is a devastating complication of diabetes, with negative impact on both prognosis and quality of life. Moreover, the diagnostic is often missed or delayed. Case report: A 50 years old male patient with dyslipidemia, overweight and hypertension was referred to our Diabetes Department in the context of newly diagnosed diabetes (HbA1C=11.7%), four days after left hallux trans-metatarsal amputation and debridement of the dorsal collection, for wet gangrene of the left hallux, with dorsal extension. The diagnostic of diabetic neuro-osteoarthropathy of the left foot was delayed several months. A good glycemic control was achieved with insulin glargine and metformin. We look further to introducing modern antidiabetic drugs with not only proven cardiovascular benefit but also good impact on weight. The patient needs to be managed by a multidisciplinary team, which has to include a podiatrist and a vascular surgeon. Conclusions: This case suggest the importance of rising diabetes and diabetic peripheral polyneuropathy awareness in all medical fields.

Plasma NAP-2 levels are associated with critical limb ischemia in peripheral arterial disease patients

IMPACT STATEMENT

Critical limb ischemia (CLI) is a serious arterial obstruction, resulting in serious reduction of blood flow to the extremities. CLI is a symptomatic disorder and is frequently not diagnosed in time. This results in a high mortality and elevated risk of limb amputation. Serum or plasma biomarkers play important roles in disease prevention, diagnosis, and prognosis. Elevated plasma neutrophil-activating peptide-2 (NAP-2) was found independently associated with CLI, but not with T2DM. Plasma NAP-2 levels might be an early CLI diagnostic biomarker and might provide a novel target for CLI treatment.